小儿行为测听在人工耳蜗调试中的应用

Application of Behavioral Audiometry for Cochlear Implants Mapping in Children

目的探讨小儿行为测听技术在人工耳蜗调试中的应用特点。方法人工耳蜗植入患儿206例,年龄1岁9个月至5岁10个月,全部使用澳大利亚Cochlear Nucleus24型人工耳蜗系统,术后一个月进行人工耳蜗编程调试。其中1岁9个月~2岁11个月小儿70例行视觉强化测听（visual reinforcement audiometry,VRA）,为VRA组,3岁2个月~5岁10个月小儿136例行游戏测听（play audiometry,PA）,为PA组,分别进行1、6、11、17、22号等指定电极通道的阈值（threshold level,TL）测试。结果145人（70%）一次性完成指定电极通道的测试,48人（23%）分二次、13人（7%）分三次完成指定电极通道的测试,VRA组与PA组之间完成测试情况存在差异（P〈0.0125）;两组中曾佩戴过助听器者大多数人第一次通过,未佩戴过助听器者大多数人第二次通过。不同频率通道完成测试所需要的次数比较,结果显示高频与低频、中频与低频之间有差异（均为P〈0.0125）,而高频与中频之间无差异（P〉0.05）。结论小儿行为测听是人工耳蜗调试及效果验证的有效方法之一,大多数小儿可以一次性完成指定电极通道的测试,3岁以内的幼儿可能需要更多的测试次数,佩戴过助听器的患儿更易于配合测试。低频电极通道较高频电极通道更易通过测试,而中频电极通道则介于这两者之间。

Objective To study clinical application of behavioral audiometry cochlear implants for mapping in children.Methods 206 children with multi— channel cochlear implants participated in this study.The threshold levels for the electrodes in two behavioral responses（visual reinforcement audiometry,VRA and play audiometry,PA,respectively）were recorded in the first mapping one month after implatation.70 cases aged 21~59 months and 136 cases aged 38~130 months were tested using VRA,PA respectively.Results For passing the test of the electrodes,145 cases（70%）were examined using the VRA or PA once,48 cases（23%）used twice,while 13 cases（7%）used three times.The majority of cases passed the first test in both VRA group and PA group,but there was a statistically significant difference in the passing rate between VRA group and PA group（P0.0125）,and there was also signifilant difference between the cases with hearing aid fitting and the one without hearing aid in this aspect（P0.01）,and the electrodes for different frequencies showed the different passing rates（P0.01）.Conclusion The behavioral audiometry is highly effective for cochlear implants mapping in children.The majority of children recipient cochlear implants could pass the first test in threshold levels for the electrodes,especially those who were more than 3 years old,or with hearing aid fitting,or the electrodes of the low frequencies showed higher passing rates.